Genetics plays a large role. SIDS is more common in boys than in girls, and it is more common in some population groups (Black, Native American, Hawaiian, Filipino, Maori).

Most of the affected infants have damaged or immature brainstems, making it difficult for them to wake up when they are in trouble. A recent series of autopsies has demonstrated visible brain abnormalities in over 70 percent of the SIDS babies examined (Pediatric Neurology, Jul 1998).

While parents often feel horribly responsible after SIDS, sometimes there is nothing they could have done to prevent it.

Almost 35,000 healthy babies in Italy had EKGs performed in the first week of life. They were then followed for a year. Most of those who ended up dying of SIDS had an abnormality on their original EKGs (a prolonged QTc interval). Those with this abnormality were more than 40 times more likely than their peers to die from SIDS (New England Journal of Medicine, Jun 11, 1998).

Anything that causes less oxygen to get to the baby in the uterus will increase his or her risk. On average, smoking during pregnancy doubles the chances, and the odds increase with each cigarette. Other drugs of abuse such as cocaine or heroin increase the risk by as many as thirty times.

The media often focus on “crack babies,” but tobacco use continues in approximately 25% of all pregnancies in the United States (J Pharmacol Exp Ther, Jun 1998). Nicotine exposure is responsible for many more SIDS deaths than any other drug of abuse, including cocaine. Stopping smoking during pregnancy is the most immediate step we can take to save infants’ lives.

Minimizing caffeine use during pregnancy is another way to protect your child. Those babies whose mothers drank 4 or more cups of coffee per day could have up to twice the risk of SIDS (Arch Dis Child, Jan 1998).

SIDS is more common in babies who sleep in warm environments, who are over-bundled, who sleep in rooms with space heaters, who are exposed to cigarette smoke, who sleep on soft surfaces, who do not use pacifiers, and those who sleep face down or in a prone position.

The rate of SIDS is higher in those babies who do not receive timely well-child care and immunizations.

Putting children to sleep on their backs lowers the risk of SIDS by about three times. Use firm bedding in a slightly cool room.

Breastfeeding may also reduce the risk of SIDS, but the studies remain inconclusive.

The SIDS rate has dropped by more than half in the last few years to 0.7 per one thousand live births in the United States. Changes in sleeping positions are being credited for the reductions (AAP News, Jan 98).

The peak period for SIDS is between two and four months old. It is very rare before one month of age, and at least 95% of all the cases have occurred before children reach six months old.

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.